STATE OF THE REGION'S HEALTH FOCUS ON OVERWEIGHT, OBESITY AND RELATED HEALTH CONSEQUENCES IN ADULTS

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1 F Region d Peel Wohkiq foh qou REPORT General Committee - - p~ DATE: October 14, 2005 SUBJECT: FROM: STATE OF THE REGION'S HEALTH FOCUS ON OVERWEIGHT, OBESITY AND Janette Smith, Acting Commissioner of Health Nick Tunnacliffe, Commissioner of Planning Dr. Hanif Kassarn, Medical Officer of Health RECOMMENDATION That the Regional Chair write to the Ontario Minister of Health and Long-Term Care and the Ontario Minister of Health Promotion to advocate for provincial legislation which would limit advertising of unhealthy foods during children's television programming as has been done in Quebec; And further, that the Regional Chair write to the Ontario Ministers of Health and Long- Term Care, Health Promotion, Transportation and Municipal Affairs and Housing to advocate for policies which strengthen public and active transportation options; And further, that the Commissioner of Health, the Medical Officer of Health and the Commissioner of Planning work with the Planning Commissioners of area municipalities to study and make recommendations for planning policies and processes that provide greater opportunities for active living in Peel. REPORT HIGHLIGHTS The "State of the Region's Health Report Focus on Overweight, Obesity and Related Health Consequences in Adults" is the fifth in the State of the Region's Health Reports series. Obesity and overweight a serious health issue affecting almost half (45 per cent) of Peel adults or about 372,000 people. Obesity and overweight are predisposing factors for type 2 diabetes mellitus, coronary heart disease, stroke, osteoarthritis and other health issues and are associated with a decrease in life expectancy and increase in early mortality. Individual behaviours, environmental factors, and genetics all strongly influence overweight and obesity. Scientific evidence has identified that adults develop their eating and physical activity patterns and behaviours as children. Obesity is difficult to treat therefore public health efforts need to be directed toward prevention using a coordinated, sustained, multisectoral approach.

2 HS-A I- 3 October 14, DISCUSSION 1. Background The "State of the Region's Health Report Focus on Overweight, Obesity and Related Health Consequences in Adults" focuses on overweight and obesity in adults, conditions that are known to reduce quality of life, increase morbidity and lead to premature death. The increasing trend of overweight and obesity represents a serious public health issue. Copies of the full report are available in the Clerk's Department and will be available on the Region's web site by the end of November. 2. Findings a) Overweight and Obesity - Overview The terms overweight and obesity are both used to identify ranges of weight that are greater than what is generally considered healthy for a given height and have been shown to increase the likelihood of certain diseases and other health problems. The prevalence of obesity continues to rise and has almost tripled in Canada since A recent study estimated the economic burden of obesity in Canada to be $4.3 billion in According to the 2003 Canadian Community Health Survey (CCHS), 31 per cent of Peel adults (aged 18 years and older) were classified as overweight and 14 per cent were obese. This represents almost half (45 per cent) of Peel adults or about 372,000 people. The proportion of overweight and obese adults increases as adults age. This means that older Peel residents are more likely to be overweight, putting them at greater risk for developing other diseases such as heart disease. b) Health Impacts of Overweight and Obesity Overweight and obese individuals are at risk of developing a number of serious conditions such as type 2 diabetes mellitus, coronary heart disease, stroke, and osteoarthritis. The risk of type 2 diabetes is strongly associated with being overweight. Although type 2 diabetes is usually diagnosed after age forty, it is now being found in all ages including children. Having diabetes in adulthood increases the risk of a heart attack and reduces life expectancy by approximately 13 years. According to the 2003 CCHS, approximately 36,900 Peel adults reported having been diagnosed with diabetes. Overweight and obesity also increase the risk of illness and death associated with coronary heart disease. In 2003, approximately 32,000 Peel adults reported having been diagnosed with heart disease. Research has also shown an association between obesity and the development of osteoarthritis of the hand, hip, back and especially the knee. According to the 2003 CCHS, 44,100 Peel adults reported having been diagnosed with osteoarthritis.

3 October 14, 2005 c) Contributing Factors to Overweight and Obesity Although a variety of factors, including individual behaviours, environmental factors, and genetics, play a role in obesity, there is growing recognition that the increasing trend of overweight and obesity is being driven by environmental factors that affect eating and physical activity behaviours. Factors creating an "obesogenic" environment include: Food is inexpensive, readily available, served in large portions and heavily advertised. The need for physical activity in our jobs and our schools has been reduced and sedentary leisure activities are heavily promoted.. Food and physical activity policies support high energy intake and low physical activity. Cultural values have allowed supersizing to become popular and perceived as added value for the dollar. Evidence also shows that people who reside in spread-out, car-dependent neighbourhoods are likely to walk less, weigh more, and suffer from obesity and high blood pressure and consequently diabetes, cardiovascular and other diseases, as compared to people who live in more efficient, higher density neighbourhoods. Sprawling suburbs with design features that discourage walking and bicycling, and which encourage residents to drive more, contribute to the epidemic of obesity. 3. Reversing the Increasing Trend of Overweight and Obesity Research shows that obesity is difficult to treat. Public health efforts, therefore, need to be directed toward prevention at all levels. A coordinated, sustained, multisectoral approach is required to reverse the increasing trend in obesity since social and environmental factors strongly influence weight (see Appendix I). Key components of a coordinated, multisectoral approach are listed below. Development of provincial and federal policies and legislation that control advertising to children; address the potential impact of food pricing options on unhealthy consumption patterns; and promote physical activity through the support of public transportation and infrastructure that encourages safe, active transportation options. Development of municipal and regional "active living by design" planning policies and processes in order to promote physical activity in everyday life. Identification of individuals in leadership positions such as elected officials to act as role models and champion overweight and obesity prevention strategies and policies. School and School Board commitment to create healthy school environments for physical activity and the availability of healthier food choices through cafeterias, vending machines, fund-raising and special food days. Access to education and skill development so that individuals and families can improve their eating habits and increase their physical activity.

4 October 14, Peel Public Health's Response Peel Public Health has developed a comprehensive strategy aimed at the prevention of childhood obesity. This strategy is based on best practice evidence and includes social marketing, health education and skill building, policy development and advocacy, environmental support and community capacity building. Scientific evidence has identified that adults develop their eating and physical activity patterns and behaviours as children. Therefore, Peel Public Health's prevention strategies to date have been focused on influencing these behaviours during childhood. For example, two comprehensive media campaigns targeted to parents of young children and school aged children have been implemented. As well, Peel Public Health has engaged both school boards in a three year initiative to reduce the risk of overweight and obesity in children. This includes development of curriculum support resources and training for teachers; development of guidelines to increase access to healthier food choices and opportunities to be physically active at school and development of safe and active routes to school. As well, Peel Public Health successfully challenged a beverage company to decrease the service size for a beverage supplied in Peel school vending machines. As well, recognizing the emerging evidence of the link between sprawling suburbs and sedentary lifestyle with obesity, there have been several requests from various local planning bodies for consultation with Peel Public Health related to the health impacts of urban planning and sprawl. FINANCIAL IMPLICATIONS The cost of implementing the program initiatives that reduce the risk of overweight and obesity is included in Peel Public Health's annual operating budget.

5 HS- Al- 6 October 14, RELATED HEALTH CONSEQUENCES IN ADULTS CONCLUSION While obesity represents a health burden at the individual and societal levels much can be done to prevent it. A coordinated, sustained, multisectoral approach is required to reverse the increasing trend of obesity since social and environmental factors strongly influence weight. Peel Public Health, in its ongoing commitment to improving the health of Peel residents, is developing and implementing a comprehensive strategy in order to reduce overweight and obesity. Janette Smith Acting Commissioner of Health Dr. Hanif Kassam Medical Officer of Health Nick Tunnacliffe Commissioner of Planning Approved for Submission: David Szwarc, Acting Chief Administrative Officer Authored By: Arlette Brobyn, Acting Director, Chronic Disease and lnjuty Prevention BjdJ ' Legislative Services Dan Labrecque, Treasurer and Commissioner of Finance o r -6 93

6 APPENDIX I October 14, 2005 Creating Environments that Promote Healthy Weights - A Shared Responsibility I TI## Healtlz Sector can prornolc healthy eallng and physical actlvlty as a mcms to improve health and prcvcnt chrmuc disemes Workplucer can provide an cnvironmcnt thitt promotes heallhy cating and regular physical activity Paren1.v and cure~ivers can adopt and model healthy hehavtiurs (breantfeedlng, healthy rating and regular physlcal acl~vity) Covrrnmenh can cstahl~sh policies that promote heallhy eating. physical activlty and healthy cnv~ronmcnts llralthy Weights ant1 Healthy Lircs for Ont~rians Communities can crcatc 817 cnvironnl~nt lllilt encourages hcalthy eating and regular physical act~vcty Scltools can provide an environment that encourages hralhy sating and regular phys~cal activity, and helm studcnts develnn the knowledge and sk~lls td nl&e heallhy chaccs --, 1 J 4- Thefood and ruerestion indusfries can dcvclop awl promote products and services lhat encourage healthy eating and physical activity Individt<ols can make lhcalthy eating choicrs and hecome more active Source: Ontario Ministry of Health and Long-Term Care Chief Medical Officer of Health Report Healthy Weights, Healthy Lives, page 45.